Behbehani Sadikah, Tulandi Togas
Department of Obstetrics and Gynecology, McGill University, Montreal QC.
J Obstet Gynaecol Can. 2015 Jan;37(1):25-31. doi: 10.1016/S1701-2163(15)30359-5.
Pregnant residents are at risk for obstetrical complications. The purpose of our study was to evaluate the incidence and type of obstetrical complications of pregnancy during residency training, and their possible contributing factors.
We conducted a retrospective cohort study using a web-based questionnaire sent to 190 residency programs, both medical and surgical, across North America. The questionnaire was distributed to all female residents, and participants were asked to answer the questionnaire only if they had ever been pregnant. The questionnaire consisted of 10 multiple-choice questions and focused mainly on the complications that residents may have encountered during pregnancy before and during their residency training. The results were compared with those of 3767 pregnant women of similar age.
The rate of obstetrical complications among residents who had up to six nights on call per month (43/163 or 26.4%) was significantly lower than those who had more than six nights on call per month (37/75 or 49.3%) (P < 0.001). Among surgical residents, 16% performed over 40 hours of surgery per week. The rate of obstetrical complications among residents who had up to eight hours of operating room time per week (8.9%) was significantly lower than among residents who worked more than eight hours per week (41.7%) (P < 0.001). When we compared obstetrical complications among residents with those of women in the general population, we found that residents had higher rates of miscarriage, hypertension in pregnancy, placental abruption, and intrauterine growth restriction.
Pregnancy during residency has a higher than average rate of adverse obstetrical outcomes. Longer operating hours and having more than six nights on call per month are associated with obstetrical complications. In addition, pregnant residents are more likely to have hypertensive disorders of pregnancy, intrauterine growth restriction, placental abruption, and miscarriages than a cohort of pregnant women of similar age.
住院医师怀孕时面临产科并发症风险。我们研究的目的是评估住院医师培训期间妊娠产科并发症的发生率和类型及其可能的影响因素。
我们开展了一项回顾性队列研究，通过基于网络的问卷对北美190个内科和外科住院医师培训项目进行调查。问卷发放给所有女性住院医师，仅邀请曾怀孕的参与者回答问卷。问卷包含10道选择题，主要关注住院医师在住院医师培训前及培训期间妊娠时可能遇到的并发症。将结果与3767名年龄相仿的孕妇的结果进行比较。
每月值夜班最多6个晚上的住院医师产科并发症发生率（43/163，或26.4%）显著低于每月值夜班超过6个晚上的住院医师（37/75，或49.3%）（P<0.001）。在外科住院医师中，16%的人每周手术时间超过40小时。每周手术室工作时间最多8小时的住院医师产科并发症发生率（8.9%）显著低于每周工作超过8小时的住院医师（41.7%）（P<0.001）。当我们将住院医师的产科并发症与普通人群中的女性进行比较时，发现住院医师流产、妊娠期高血压、胎盘早剥和胎儿生长受限的发生率更高。
住院医师培训期间妊娠的不良产科结局发生率高于平均水平。手术时间延长和每月值夜班超过6个晚上与产科并发症有关。此外，与年龄相仿的孕妇群体相比，怀孕的住院医师更易发生妊娠期高血压疾病、胎儿生长受限、胎盘早剥和流产。
